2017 AHC/NCAL Annual Convention & Expo
Who's Paying the Bill? Understanding Today's Payment Models and the Data You Need for a Strong Bottom Line
We ask a lot of questions in post-acute care (PAC), but the first and often most critical one is, “Who’s paying the bill?” Due to health care reform and the 2016 election results, the answer to this question is changing in a dramatic way. Buried in the regulations of PAMA, IMPACT, and the Final rule is the new quality metrics making their way into the reimbursement system. Post-acute providers face a host of operational challenges that come with shorter lengths of stay and an increased volume of payers. Your staff are juggling determination of primary and secondary payer verification for eligibility, MDS schedules, and managed care authorizations. Billing the right payer the right way is essential to your revenue cycle, and mistakes leave you waiting for your cash. Mandatory bundled care programs shift the risk away from Uncle Sam and onto you and your network of colleague providers. Not to mention that getting paid for services rendered in a value-based market is complicated. This session will explain who is paying the bill today, exploring the major payers and payment models in the SNF space. Recent research findings from pioneer ACO and other payers will be shared and the lessons learned outlined. Case examples will illustrate key performance metrics that operators should focus on to ensure a healthy bottom line.
Learning Objectives:
- Describe three major changes in the Payer landscape and the key data metrics each demands
- Define three changes in payment models that represent the shifting of risk
- Identify through research findings and case studies five key data elements needed for success in the changing reimbursement environment
Cheryl Field, MSN, RN, CRRN
Chief Product Officer
Prime Care TechnologiesDisclosures: Prime Care Technologes: Employee